Mishawaka High School
Early College Program Application Part A: to be completed by parent/guardian Student Name:_____________________________________________________________________________________ last
first
middle
Date of Birth:_________________________________________ MM/DD/YYYY
Parent/Guardian #1 Name:____________________________________________________________________ last
first
middle
Address:____________________________________________________________________ street
______________________________________________________________ city
state
zip
Parent/Guardian #2 Name:___________________________________________________________________ _last
first
middle
Address:____________________________________________________________________ street
______________________________________________________________ city
Who does the student live with? P/G#1
❒
P/G#2
state
❒
Both ❒
Education level of parent/guardian #1: _____________________________ pick one from list on the right Education level of parent/guardian #2: _____________________________ pick one from list on the right Does the student receive free or reduced lunch? Yes
zip
GED HS diploma Some college Associate’s degree Bachelor’s degree Master’s degree Professional or Doctoral degree
❒ No ❒
Essential family support: 1. You must ensure that your child is available to participate in the 3-week bridge program each summer, if required. 2. You must provide a quiet and safe place for your child to study/do homework for one to two hours per night. 3. You must check weekly on your child’s progress and that they are completing all assignments on time. 4. You must work closely with your child and the school in setting realistic goals and support your child in achieving them. I understand the above requirements and agree to do by best to support my child in reaching their Early College goals. _______________________________________________ (signature)
_______________________________________________ (signature)
Part B: to be completed by student Pick one that most interests you from the following list: ❒ Business ❒ Manufacturing and Construction ❒ Culinary Arts, Hospitality & Human Services ❒ PLTW Biomedical and Health Science ❒ Performing Arts ❒ PLTW Engineering and Technology ❒ Visual Arts and Communications ❒ STEM (focus on Science, Technology, Engineering, Mathematics) ❒ Liberal Arts (balance of core subjects) Why do you want to be a part of the EC program? (optional)
Who is your English teacher? Math Teacher? _____________________________ _____________________________
(English)
(Math)
Student commitment: 1. You must participate in the 3-week bridge program each summer, if required. 2. You must study/do homework for one to two hours per night. 3. You must complete all assignments on time. 4. You must work closely with your parents and the school in setting realistic goals and strive to complete them. I understand the above requirements and agree to do by best to reach my Early College goals.
_______________________________________________ (signature)
Part C: to be completed by student’s MHS Guidance Counselor Type of 8th grade English course completed (regular/honors) and 1st semester grade _______________________________________________ (course)
___________ (letter grade)
Type of 8th grade Math course completed (pre-Algebra/Algebra…) and 1st semester grade: _______________________________________________ (course)
___________ (letter grade)
Most recent ISTEP+ results (…pass, pass+):
Cumulative 1st semester GPA
___________ ___________ ___________ (English/LA) (Math) (GPA) Guidance Counselor Comments:
Do you recommend the student for EC? Yes ❒ No ❒
_______________________________________________ (signature)
